Provider Demographics
NPI:1982988986
Name:MIDTOWN BACK AND NECK CENTER
Entity Type:Organization
Organization Name:MIDTOWN BACK AND NECK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERENCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-932-1277
Mailing Address - Street 1:3141 LOCUST ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1230
Mailing Address - Country:US
Mailing Address - Phone:314-932-1277
Mailing Address - Fax:314-932-1278
Practice Address - Street 1:3141 LOCUST ST STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-1230
Practice Address - Country:US
Practice Address - Phone:149-321-2773
Practice Address - Fax:314-932-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-09
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011021467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty